10. Menses Flashcards
Menarche (def)
Onset of menstruation during puberty
When does menses begin? (4)
- When the brain, ovaries and adrenal glands are mature
* When body fat is adequate
Perimenopause (def)
Period of time when ovarian function regresses (process, not event)
Climacteric (def)
A period of reproductive decline
Menopause (diagnostic def)
When a woman has stopped bleeding for 12 months – retrospective diagnosis.
Hormonal changes with menopause
Ovaries no longer producing estrogen, progesterone
Role of estrogen (menses) (6)
- Control the development of the female secondary sex characteristics
- Assists in the maturation of the ovarian follicles
- Ensures that the endometrial mucosa is in a ready state
- Estrogens also cause the uterus to increase in size and weight
- Hormonal regulation
- Increases libidinal feelings in humans
Secondary sex characteristics controlled by estrogen (4)
o Beast development
o Growth of body hair
o Widening of the hips
o Deposits of the tissue (fat) in the buttocks and mons pubis
Progesterone is secreted by ____
The corpus luteum
Progesterone is found in the greatest amounts during what phase of the menstrual cycle?
The luteal phase
Functions of progesterone (2)
- Decreases uterine motility and contractility caused by estrogens
- Causes the uterine endometrium to further increase its supply of life-sustaining components
Progesterone causes the uterine endometrium to further increase its supply of (5)
- glycogen
- arterial blood
- secretory glands
- amino acids
- water
Prostaglandins (def)
Oxygenated fatty acids that are produced by the cells of the endometrium
Two types of prostaglandins discussed in class
Prostaglandin E (PGE) Prostaglandin F (PGF)
Characteristics of PGE (3)
PGE = Potent vasodilator
o Relaxes smooth muscle
o In sperm
Characteristics of PGF (2)
PGF = Potent vasoconstrictor
o Increases the contractility of muscles and arteries
Menstruation (def)
Periodic uterine bleeding that begins approximately 14 days after ovulation
Hypothalmic-pituitary (menstruation - def)
Negative feedback cycle that stimulates ovaries
Ovarian (menstruation - def)
Cyclic selection of a mature oocyte for ovulation
Endometrial (menstruation - def)
Cyclic proliferation and shedding of functional layer of the endometrium
3 concurrent cycles in menses:
- Hypothalmic-pituitary
- Ovarian
- Endometrial
Hormones involved in the hypothalmic-pituitary cycle
GnRH (Gonadatropin Stimulating Hormone)
Phases of the ovarian cycle, and when each occurs (2)
- Follicular Phase: Days 1-14
* Luteal phase: Days 15-28
What occurs during the follicular phase of the ovarian cycle?
One follicle is “selected” for ovulation
Follicular phase: Dominant hormone
Estrogen
What happens during ovulation? (Timing, hormones)
o Estrogen from ovarian follicles stimulates LH surge
o Occurs 34-36 hours after the LH surge begins (10-12 hours after LH peak)
What occurs during the luteal phase of the ovarian cycle?
What was the follicle becomes the corpus luteum
Luteal phase: Dominant hormone
Progesterone
Phases and timing of the endometrial cycle (4)
- Menstrual phase (Days 1-5)
- Proliferative Phase (Days 6-14)
- Secretory phase (Days 15-26)
- Ischemic phase (Days 26-28)
Menstrual phase of endometrial cycle: What happens + hormonal reason
Shedding of the endometrium due to low estrogen levels
Proliferative phase of endometrial cycle: What happens?
- Period of rapid endometrial thickening
* Restoration of endometrial surface
Secretory phase of the endometrial cycle: What occurs (and why)? (3)
- Endometrium becomes edamatous and vascular (enables blood supply for implanted ovum)
- Glycogen secreted (to prepare for fertilized ovum)
- Progesterone increased from corpus luteum
Ischemic phase of endometrial cycle: What happens (2)
- Levels of estrogen and progesterone fall rapidly
* Corpus luteum degenerates
Three other cyclic changes surrounding menstruation
- Basal Body Temperature changes
- Spinnbarkheit
- Miittelschmirtz
Changes in basal body temperature (2)
o Lowers prior to ovulation
o Elevates post-ovulation – Due to a rise in progesterone
Spinnbarkheit (def)
Cervical mucus thin and stretchable (egg whites)
Miittelschmirtz (def)
One-sided lower abdominal pain that coincides with ovulation
Five menstrual cycle irregularities
o Amenorrhea o Oligomenorrhea o Menorrhagia o Metrorrhageia o Dysfunctional Uterine bleeding (DUB)
Amenorrhea (def)
Lack of period
Oligomenorrhea( def)
Light period
Menorrhagia (def)
Excessive menstrual bleeding in duration or amount
Metrorrhageia (def)
Spotting or hemorrhaging between normal cycles
DUB (def)
3 characteristics
Dysfunctional Uterine Bleeding
- Any bleeding that is irregular in amount, duration or timing and not related to normal menstrual bleeding. *Usually excessive.
- Associated with ovulation.
Primary amenorrhea (2)
- Absence of menarche and secondary sex characteristics by age 14
- Absence of menarche regardless of secondary sex characteristics by age 16
Secondary amenorrhea
• A six month cessation of menses after a period of menstruation
Causes of amenorrhea (7)
- Pregnancy
- Various diseases
- Stress
- Eating disorders
- Strenuous exercise
- Hormonal contraceptive
- Menopause
Dysmenorrhea (Def)
Painful menstruation
Dysmenorrhea (prevalence)
Affects 50-80% of women
Primary dysmenorrhea (def)
Associated with ovulatory cycles
Secondary dysmenorrhea (def)
Acquired menstrual pain developed later in life ( >25 years old)
Symptoms associated with primary dysmenorrhea (5)
- Backache
- Weakness, dizziness, syncope
- Sweating
- GI upset, anorexia, diarrhea, nausea, vomiting
- Headache
Primary dysmenorrhea: Treatment (2)
NSAIDs, fluids
Cause of primary vs Secondary dysmenorrhea:
Primary dysmenorrhea: Associated with ovulatory cycles
Secondary dysmenorrhea: Associated with pelvic pathology
Five types of pelvic pathology associated with secondary dysmenorrhea
- Adenomyosis
- Endometriosis
- Pelvic Inflammatory Disease (PID)
- Polyps
- Fibroids
Adenomyosis (def)
Endometrial tissue that grows into the muscular wall
Endometriosis (def)
Endometrial lining grows outside of the uterus
Premenstrual syndrome (def)
Physical and psychological symptoms beginning in the luteal phase of the menstrual cycle
Premenstrual syndrome: Symptoms (6)
- Water retention
- Behavioral/emotional changes
- Premenstrual cravings
- Headache
- Fatigue
- Backache.
Treatment for Premenstrual syndrome (3)
- NSAIDs
- Loop diuretic (Lasix) for bloating
- SSRIs for mood stabilization
Endometriosis: Characteristics (6)
- Secondary amenorrhea
- Dyspareunia – Painful intercourse
- Abnormal uterine bleeding
- Infertility
- Pain during exercise because of adhesions
- Bowel problems – endometrium can go into bowel
Endometriosis treatment (2)
NSAIDs
Heat (to increase bloodflow to the pelvis)
Endometriosis Diagnosis (2)
Ultrasound, clinical history
Uterine polyps: Def
o Tumors on stalks arising from mucosa
Where can uterine polyps occur? (2)
- Endometrial
* Cervical
What are the most common benign lesions of the cervix and endometrium occurring in reproductive years?
Uterine polyps
What are fibroids
Benign, slow-growing tumors
Fibroids: Types (5)
- Intramural
- Subserosal
- Submucosal
- Cervical
- Pedunculated
Which type of fibroid is least common & most symptomatic? Why?
SUBSEROSAL
• Affects the menstrual cycle
Four causes of fibroids
- Hormone replacement therapy (HRT)
- Estrogen Replacement therapy (ERT)
- Pregnancy
- Oral contraceptive pills
Treatment of fibroids (3)
- NSAIDs for inflammation
- Oral contraceptive pills (Keeps level stable)
- Myomectomy – removal
